<p>Regional analgesia is a cornerstone of multimodal pain management for hip fractures, yet the optimal choice between the pericapsular nerve group (PENG) block and the fascia iliaca compartment block (FICB) remains a subject of ongoing debate. Current literature often presents conflicting outcomes due to the heterogeneous pathophysiology of hip fractures which complicates a universal approach. This narrative review synthesizes current anatomical and clinical evidence to reconcile these discrepancies. By evaluating the relative strengths and limitations of each technique, we identify three critical dimensions including pathology, patient factors, and performance. Our synthesis indicates that pathology dictates the target. Based on anatomical considerations, intracapsular fractures may benefit from the targeted coverage of the PENG block, whereas extracapsular injuries involve somatic pathways that appear more effectively addressed by the FICB. Patient-centered priorities like delirium prevention in the frail elderly must be balanced against the theoretical benefits of motor sparing. Furthermore, the clinical utility of motor preservation is only realized when coupled with early active rehabilitation. Consequently, the PENG block and FICB should be viewed as complementary rather than competitive strategies. This review offers the 3P framework as an evidence-based synthesis tool to assist clinicians in personalized technique selection. Future research should prioritize defining which technique best suits specific patient phenotypes and functional goals instead of pursuing a universal gold standard.</p>